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Home / Health / When the tick threat explodes, restraining the state in combating climate change can endanger public health

When the tick threat explodes, restraining the state in combating climate change can endanger public health



Maine's invasion came earlier this year. In the last days of tick activity – from Scarborough to Belfast and Brewer – people say they discovered the eight-legged arachnida before spring. They noticed the ticks – which look like moving poppy seeds – that invade streets, beaches, playgrounds, cemeteries and library floors. They saw them clinging to dogs, birds and squirrels.

In May, people found the ticks crawling on their legs, back and neck. Now, in midsummer, daily encounters seem almost impossible to avoid.

Maine is home to 15 types of ticks, but only one public health threat: the black-legged tick ̵

1; called the "deer tick" – a carrier of Lyme and other debilitating diseases. For 30 years, an army of deer ticks has penetrated about 350 miles from the southwest corner of the state to the Canadian border, infesting cities such as Houlton, Limestone, and Presque Isle.

"It's appalling," says Dora Anne Mills, director of the Center for Excellence in Health Innovation at the University of New England in Portland. Mills, 58, says she never saw deer ticks in her native land until the year 2000. The ticks have brought an increase in Lyme disease in Maine over two decades, the reported cases of 71 in 2000 to 1,487 in 2016 – a twenty-fold increase, show the latest federal data. Today, Maine tops the nation in per capita Lyme incidence, outperforming hot spots like Connecticut, New Jersey, and Wisconsin. Deer tick diseases such as anaplasmosis and babesiosis – a bacterial infection or a parasitic disease similar to malaria – follow a similar development.

The explosion of the disease correlates with a warmer climate in Maine, where it has been for decades in the last three years, the summers are generally hotter and longer and the winters milder and shorter.

It's a strand in an ominous rug: Across the United States, diseases transmitted by the ticks and mosquitoes, some potentially deadly, are not seen in places and volumes previously seen. Climate change is highly likely to blame, according to a 2016 report by 13 federal agencies warning of the escalation of heat, storms, air pollution and infectious diseases. Over the past year, a coalition of 24 academic and government groups has sought to track health-related climate-related risks worldwide. They found them "far worse than previously understood" and endangered half a century of public health.

A female deer tick Staff photo by Gordon Chibroski

Still in Maine, Gov. Paul LePage – a conservative Republican who has challenged the science of global warming, will not acknowledge the phenomenon. His government has repressed state plans and veto legislation to limit damage. Former government officials say state officials, including those at the Maine Center for Disease Control and Prevention, have been told not to discuss climate change.

"It seems that the problem has been swept under the carpet," says Mills Maine CDC from 1996 to 2011. In the 2000s, she was tasked in a government task force with the development of climate change plans; These efforts obviously went ahead in vain.

"We all know this answer when we ignore it and hope it disappears," she says. "But it never goes away." (Mills sister, Attorney General Janet Mills, who is the governor's Democratic candidate this year, has repeatedly clashed with LePage over the years.)

LePages office denied this in an e-mail message The governor has climate change ignored. He cited his creation of a voluntary, interinstitutional working group on climate change in 2013, which includes the Maine CDC. "It is wrong to assume that the governor has issued a blanket ban on doing anything related to climate change," the statement says. However, an up-to-date inventory of the group's government climate activities shows that most of the work of the health department came from the previous administration.

This is important because the health authorities can not curb an epidemic worsened by global warming attention to the climatic link. Maine's CDC had an ambitious strategy that would have helped it overcome the problem, experts say. This strategy was based on predicting how impending climate change in Maine could increase the risk of tick infections. This will allow officials to warn people of where the vector-borne diseases are going next and devise attack plans. But the state has not made it

Because ticks are moving into new areas – and pushing further north – it's not enough for health departments to warn people of places that pose Lyme risks today, says Jonathan Patz, one Environmental health professor at the University of Wisconsin-Madison, who has studied the effect of the environment on vector-borne diseases since the 1990s. If all the agencies do, they are "only reactionary".

CLIMATE-SENSITIVE DISTRIBUTION

The role of climate in the intensification of diseases carried by "vectors" – organisms that transmit pathogens and parasites – is not as obvious as in heat or heat pollen allergies. But it is a serious threat. Of all infectious diseases, those caused by bites from ticks, mosquitoes and other cold-blooded insects are the most climate-sensitive, scientists say. Even small temperature changes can change their distribution patterns.

In May, US Centers for Disease Control and Prevention reported a tripling in the number of illnesses caused by mosquito, tick and flea bites across the country over 13 years – from 27,388 cases in 2004 to 96,075 a year 2016. Cases of tick disease doubled during this period, accounting for 77 percent of all vector-borne diseases.

CDC officials who did not mention the words "climate change" partially acknowledged this increase

Officials like LePage are one reason the government has been so hesitant about the human impact of climate change. However, the disagreement within the health community has also hindered action, according to interviews with more than 50 public health experts and lawyers, as well as a review of dozens of scientific studies and government reports. State and local health officials might believe that climate change is taking place but not necessarily seeing a public health crisis, polls show. Many find it too strenuous or nebulous to tackle a problem.

"Like most health departments, we are underfunded and our list of responsibilities is growing every year," wrote an Arizona investigator who reflects the 23 professionals who respond to a Center for Public Integrity Online Questionnaire

Griffin Dill, Director of the Tick Identification Program at the Cooperative Extension of the University of Maine has been sampling in this converted office for five years. "We are still so inundated with a tick-borne illness," he says. "We try to stuff holes in the dam." Photo by Kristen Lombardi / Center for Public Integrity

The strained policy of climate change is also emerging. Chelsea Gridley-Smith, a Senior Program Environmental Health Analyst at the National Association of City and County Health Officials, says many local health departments are facing political pressure. Some encounter official or supposed prohibitions of the term "climate change". Others struggle to convey the urgency of threats when their peers do not detect a crisis.

"It is daunting for people working in the climate and health," says Gridley Smith, whose group represents nearly 3,000 departments. "When politics comes into play, they feel a bit depressed."

This reality is noteworthy in Maine, among 16 states and two cities receiving a federal grant designed to boost health departments' responses to climate-related risks. As part of the program – Building Resilience Against Climate Effects (BRACE) – federal CDC employees help their regional and local counterparts use climate data and modeling research to identify health threats and develop prevention strategies. National leaders praised the BRACE work of the Maine CDC, which includes Lyme disease.

Cooper Leonard, north of Bangor, developed a rash in 2016 and has been tested positive for Lyme disease. The boy, 7 at the time, could hardly walk during his treatment with antibiotics, his mother said. Photo courtesy of Regina Leonard

Maine's CDC refused to interview key personnel and answered no written questions. Instead, a spokeswoman sent a brief e-mail describing initiatives to help people avoid tick bites and Lyme borreliosis. Former government officials say the LePage government is concerned about diseases caused by ticks but not their connection to the climate. In his statement, the governor's office said that this relationship "is of secondary importance to the immediate health needs of people in Maine."

Meanwhile, the ticks continue their northern creep. In Penobscot County – where the Lyme incidence rate is eight times higher than in 2010 – the increase has unnerved the residents. Regina Leonard, 39, a lifelong Maineer living seven miles north of Bangor, does not know what to make of climate change. But she says the deer tick seems "rampant".

In 2016, her son Cooper, then 7, tested positive for Lyme disease after development, which she now identifies as a spreading or "common" rash, a classic symptom. Red patches appeared on his cheeks as if sunburnt. The patches coincided with other ailments – malaise, nausea. Weeks later, they circled his eyes. The ring-shaped rash spread from his face to his back, stomach and wrists.

Leonard says Cooper could barely go on antibiotics during his 21-day therapy. His fingers curled under his hands. He stuttered. The thought of being bitten by another tick terrifies him to this day.

"At this rate," says Leonard, "we will all end up with Lyme."

DRAMATIC INCREASES IN SEVERAL STATES

The prevalence of Lyme disease has followed that of deer ticks. Lyme incidence has more than doubled in the last two decades. In 2016, federal health officials reported over 36,429 new cases, and the disease has increased well beyond endemic areas in the northeast to west, south and north.

The official census, which was driven by laboratory tests, highlights the public health problem. Experts say. In some states, Lyme disease is so prevalent that the health authorities no longer need blood tests to confirm the early diagnosis. The test process, which measures an immune response against the Lyme-causing bacteria, also has limitations. It misses patients who have no such reaction. Those who show symptoms associated with a later stage – neurological problems, arthritis – may face inaccurate outcomes. The CDC estimates that the actual number of cases could be 10 times higher than reported.

Dr. Saul Hymes has led a pediatric tick-borne disease center since the discovery of the disease in 1975 at Stony Brook University on Long Island. He has noticed a change: patients go to his office in March and until November. Often they appear in winter. Deer tick samples collected at the university's Lyme lab between 2006 and 2011 show an increase in tick activity in December and January.

Today, the Maine Centers for Disease Control's climate and health program amounts to just over half a dozen initiatives on ticks and tick-borne diseases.

States where Lyme barely existed 20 years ago experience dramatic changes. In Minnesota, stag ticks and the diseases that cause them appeared in several southeastern counties in the 1990s. But the tick has spread north and brought disease-causing bacteria with it. Now, in newly infested areas, David Neitzel of the Vector-Borneed Disease Unit of the Minnesota Department of Health says, "We could not find any clean ticks, they're all infected." Minnesota ranks among the nation's top five states in Lyme cases; The incidence of anaplasmosis and babesiosis is even higher.

A similar transformation is underway in Maine, where 1,769 Lyme cases increased 19 percent in 2017 compared to the previous year. Anaplasmosis cases increased by 78 percent during this period, and babesiosis by 42 percent.

"It's a pretty notable change in a relatively short space of time," says Dr. Robert Smith, Director of Infectious Diseases at Maine Medical Center, Portland. Researchers at the hospital's hospital-borne disease laboratory have followed the deer-tick march across all 16 counties in Maine since 1988. Through testing, they have identified five of the seven pathogens affected by deer tick. These are five new, life-threatening diseases.

Lisa Jordan, a patient advocate living in Brewer, says she has already been swamped by phone calls from Lyme sufferers. In her dead end, she counts 15 out of 20 affected households. Three of their family members, including themselves, are among them. "It's a huge epidemic," she says.

TEMPERATURES RISE, DEATH TRIPS IN

The link between Lyme disease and climate change is not as direct as with other vector-borne diseases. Unlike mosquitoes, which live one season and fly everywhere, deer ticks have a two-year life cycle and depend on animals for transport. That makes their hosts the most important disease drivers. Young ticks feed on mice, squirrels and birds, but adults need deer – some suggest 12 per square mile –

Rebecca Eisen, a federal CDC biologist who has studied the influence of climate on Lyme, notes that deer ticks The eastern coast dominated until the 19th century, when the forests had to give way to the fields. The transition has almost wiped out the tick that thrives in the foliage of oak and maple. The spread of deer leeches since the beginning of Lyme data collection in the 1990s can be partly attributed to a decline in agriculture, which has thrown back forests, while the suburb has spread to the edges of the forest and provided the perfect habitat for the ticks. that the change in land use patterns is behind Lime's spread in the mid-Atlantic states, such as Pennsylvania, where the incidence rate has more than tripled since 2010. "It did not get much warmer there," she says.

But the climate plays a role. Ben Beard, Deputy Director of the CDC's Climate and Health Program, says warming is the main culprit in Lyme North. Research by the CDC suggests that the deer tick, which is sensitive to temperature and humidity, moves farther into the Arctic latitudes, while warm months get hotter and longer. Rising temperatures affect tick activity, which drives the Lyme season beyond its summer start.

Canada embodies these changes. In the past 20 years, Dr. Nicholas Ogden, chief public health researcher, observes how the ticks population in Canada spreads from two isolated pockets near the north shore of Lake Erie to Nova Scotia, Quebec, and Ontario, lines he calls "a vector-transmitted disease emergency."

Scientists say ticks can use snow as a blanket to survive the cold, but long winters will limit the deer tick and prevent it from implanting itself on the host and becoming adults. In the 2000s, Ogden and colleagues calculated a temperature threshold to withstand Canada's winter. They speculated that every day above freezing – measured in "degree days" – a cumulative heat sum – would accelerate its life cycle so that it could multiply and survive. They mapped their theory: as the temperatures rose, deer ticks moved in.

By 2014, researchers had published a study examining projected climate change and tick reproduction. It shows higher temperatures associated with higher rates of tick breeding, five times in Canada and twice in the northern United States; In both places, the study shows that a Lyme invasion has followed.

The Canadian Department of Health reports a seven-fold increase in Lyme cases since 2009. "We know it's associated with a warming climate," says Ogden

The Environmental Protection Agency (EPA) did so in 2014 It was much concluded when she described Lyme disease as the official "indicator" of climate change – one of two vector infections receiving the award. In its description, the EPA distinguishes the cases of four northern states, including Maine, where Lyme has become the most common.

Maine researchers have found a strong correlation between tick activity and milder winters. It is predicted that the warming in Main's six northernmost parts of the country, which together could reach 650 days more than freezing every year by 2050, will make them as hospitable to deer as the rest of the state.

MUTED FEDERAL RESPONSE SHIPS BURDEN

Research like this is crucial, experts say. But the federal government has failed to prioritize it. From 2012 to 2016, the National Institutes of Health spent $ 32 million on their main program on climate change – 0.1 percent of their $ 128 billion budget, says Kristie Ebi, a professor of public health at the University of Washington. NIH spending has risen to an average of $ 193 million a year over the last two fiscal years. But that's still less than the $ 200 million Ebi needs every year, according to health authorities, to create programs that protect Americans. And NIH spent 38 times that much on cancer research during the two years.

Congress has done little to solve the problem. Last year, US MP Matt Cartwright, a Democrat from Pennsylvania, supported legislation calling for an increase in federal funds for climate and health research, and for drawing up a national plan to support state and local health departments. The bill, which is sponsored by 39 Democrats in the House of Representatives, languishes in the committee. As long as Republicans have a majority, they have little chance of progress.

The only state support to state and city health authorities on climate change is the CDC's BRACE scholarship program. George Luber, head of the CDC's Climate and Health Program, sees it as "forward-thinking public health thinking." He intends to extend it to all 50 states, but financial constraints have kept him from doing so.

Republicans in Congress I have repeatedly tried to cut BRACE's budget of $ 10 million, without success. His average annual health department award has been around $ 200,000 for nearly a decade.

The federal's modest response has shifted the burden on state and local health departments, most of which have limited awareness of climate change as a public health problem. According to a report from the Government Accountability Office 2014. Of the two dozen respondents who responded to the center's questionnaire, only one said their authorities had educated people about climate risks and drafted an adjustment plan.

States are hailed as national models for climate health adaptation: In Minnesota, New Hampshire, Rhode Island and Vermont – where deer and their diseases move north – health authorities have modeled future climate change and started to launch awareness campaigns in areas where Lyme is expected

& # 39; RESEARCH ENVIRONMENT

Mills, the former head of the CDC in Maine, oversaw the offer of the Department for a BRACE Scholarship in 2010. Government epidemiologists were already involved Tick ​​diseases, but nobody asked why deer ticks spread and which areas were in danger. [19659002] A year later, the department launched a program that prioritizes vector-borne diseases and extreme heat. Some staff members worked with experts to model high-temperature days and analyze their relationship with heat-induced hospital visits. Much of the funding went to climate researchers and vector ecologists, who studied the relationship between deer ticks and warming temperatures, and conducted a similar study with mosquitoes. They planned to develop a broader tick model that examined the climatic and environmental processes that underlie the spread of Lyme disease in Maine and project its future exposure.

Until 2013, the administration of LePage 2010 was chosen as the denier of "Al-Gore science", clinging to climate change. Norman Anderson worked at the CDC in Maine for five years, leading his climate and health program. He recalls that public relations officials have warned him against talking about his work and refusing to bring his performances to the countryside.

Finally, the governor abolished research on the department's climate change. Scientists say they have had to replace their ambitious model plan with rudimentary activities and spent their remaining BRACE funds on "tick kits" – complete with cups of venison stalks in nymphs and adult stages – to distribute to schoolchildren.

"Governor LePage said," No one is doing climate change research, "says Susan Elias, a vector ecologist at the Climate Change Institute at the University of Maine who has worked on tick-climate research and is developing the broader model for her doctoral thesis." This news came from above official state channels. "

LePage's office defended the governor's decision, arguing that scientists studying the relationship between climate and disease" are best funded in research environments such as large universities, "not the Maine CDC. [LePageagreedwithaproposalfromMaine'sCDCtorenewitsBRACEgrantbutonlyafternarrowingitsscopesayingthatstaffhadtoabandonplannedclimateresearchonthehealtheffectsofextremeweatherandworseningpollensinrecordsTheirheatresearchyieldedresultsinfactthethresholdatwhichofficialsissuedangerouswarmingrecommendationswasloweredfrom105to95degreesFahrenheitaftertheiranalysisfoundthatitdidnotprotectMainers'healthButtheemployeesstillhadtodiscardtheirheatresponseplansTheonlyBRACEworkapprovedbyLePageconcernedLymeprevention

In 2014, Anderson, frustrated with what he calls the "repressive" environment, left the CDC of Maine. The larger "Strategy of the Department of Climate and Health" had just been abolished.

ALREADY ANOTHER ZECKARTE

Today, the Maine CDC's Climate and Health Program is little more than half a dozen initiatives on ticks and tick-borne diseases. Health officials, for example, have developed voluntary school curricula and online campaigns for the elderly. They have created training videos for school nurses and librarians.

The Department's "Most Important Prevention Message Encourages Maine Residents and Visitors to Use Personal Protective Measures to Prevent Tick Exposure," a 2018 report said.

This report, submitted by the Maine CDC with state legislators, suggests on the short-sighted focus of the department on the accelerating public health problem. The vector-borne disease working group of scientists, pest controllers and patient representatives has extensive knowledge of ticks and tick-borne diseases, but has no mandate to devise a nationwide response plan, members say. The published materials do not mention Lymes connection to climate change.

Former civil servants say that prevention work is best with limited resources. At $ 215,000 a year, the BRACE grant, which is $ 1.1 million over five years, is not enough to serve a 38,385 square mile state, with a population of 1.3 million. No state money is directed to the rise of diseases by ticks.

The LePage office quotes the governor's leadership in building a $ 8 million research facility at the University of Maine that opened last month. The lab – the result of an election campaign initiative in 2014 – houses the university's tick identification program. Director Griffin Dill sees it as a major improvement over the remodeled office where he has been tracking ticks for five years. It will allow him to expand tick control and test ticks for pathogens. Nevertheless, he is honest about the overall picture.

"We are still so swamped with tick-borne diseases," says Dill. "We try to stuff holes in the dam."

Already threatening a new threat. Scientists consider the lonely star a better signal of climate change than its black-skinned counterpart – it has long prospered in southern states such as Texas and Florida, but has moved north. In Maine, tick ecologists have been collecting solitary star species since 2013. Dill examined fields and yards in search of sedentary populations, pulling something that looked like a white flag onto a stick. He says the tick does not survive Maine's winter yet.

It can still bring new and unusual diseases. Patty O'Brien Carrier suffered what she describes as a bizarre reaction – itchy hives, flushed face, swollen throat – twice before she learned she has the Alpha-Gal syndrome, a rare allergy to meat. In February, laboratory tests identified its source: a tick bite of a lonely star. A "wild gardener" from Harpswell, O & Brien Carrier, 71, believes she was bitten in her garden. She spends her time in the dirt, surrounded by roses, daisies and other perennials. She sees more ticks in her garden, she says, as if she would thaw the soil earlier every spring.

In November, O & Brien Carrier pulled a bloated tick from her neck. It was the size of a sesame, concave in shape, with a white dot on its back – just like the lonely star. "His face was right in my neck and his legs were twisting," she says. "It was pretty disgusting."

Now, O & # 39; Brien Carrier performs the same ritual every time she goes outside: she applies tick repellent to her clothes and skin. She knits elastically around her pants and pulls up her knee socks. She adds boots, gloves and a hat.

"It's like a war zone out there," says O & Brien Carrier, "and I can not be bitten by another tick."

The Center for Public Integrity is a non-profit investigative news organization based in Washington, DC

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